Respiratory viral infections (RVIs) affect millions annually, yet long-term consequences outside COVID-19 are poorly defined. Post-acute sequelae, encompassing persistent or new physical, cognitive, and mental health impairments, are increasingly recognised as clinically important. We systematically reviewed evidence on post-acute outcomes in adults following non-COVID RVIs to characterise pathogen-specific patterns and highlight areas for future research. Major databases were searched from January 2004 to August 2025 for observational studies reporting symptoms, functional impairment, or new diagnoses ≥ 4 weeks after RVIs. Study characteristics, pathogens, follow-up duration, and organ-specific outcomes were extracted. Risk of bias was evaluated using ROBINS-I, and certainty of evidence was determined with the GRADE approach. Narrative synthesis was performed owing to heterogeneity. Thirteen studies (n = 631,863) met eligibility criteria. Influenza was the most studied pathogen and consistently associated with long-term pulmonary dysfunction, reduced diffusion capacity, dyspnoea, fatigue, and poorer quality of life. Large cohorts corroborated substantial pulmonary morbidity and less frequent cardiovascular and neuropsychiatric burdens. Two RSV cohorts (n = 1553 and n = 471) showed a predominance of cardiovascular sequelae; respiratory and neurological outcomes were less frequent. A single HMPV cohort (n = 92) reported persistent symptoms in 55% of adults at 90-270 days, most commonly dyspnoea, fatigue, and cough. Overall, the available evidence suggests that non-COVID RVIs are associated with post-acute multi-organ sequelae, particularly following severe infection. Nevertheless, evidence remains fragmented due to inconsistent study designs, limited pathogen coverage, and low certainty. Standardised, prospective, pathogen-specific studies are required to refine these preliminary signals and inform clinical follow-up and prevention strategies.

Tuberculosis (TB) caused by acid-fast bacilli is one of the leading causes of morbidity and mortality in developing countries. Pakistan has the world's fifth-largest prevalence of TB, with 276/100,000 cases in prevalence and a mortality of 34/100,000. Delayed diagnosis, disruptions in treatment continuity and a lack of awareness are the key issues leading to multidrug-resistant TB. The current study aimed to find out the determinants of delayed pulmonary TB in a rural district of Khyber Pakhtunkhwa Province, Pakistan. The cross-sectional study was conducted in six TB control program centers designated by the National TB Control Program from March to December 2024. Data were collected from 250 eligible patients, and after removal of incomplete questionnaires, the data of 229 patients were analyzed. The study was approved by the district TB officer, and participants' consent was obtained before data collection. A delay of >21 days was considered the cutoff point for delayed TB diagnosis. Among 229 patients, 51.1% were male and 48.9% female participants, with a mean age of 33.31±21.32 years. The mean diagnostic delay was 23.66±14.94 days. Descriptive analysis of data showed 52% of delayed TB diagnosis cases; 92.2% of the studied patients were from rural areas, in which 80% of delayed TB diagnosis cases were reported. Male gender [odds ratio (OR)=2.31], getting treatment from public hospitals (OR=4.13), age group 31-45 years (OR=3.10), presence of acute extrapulmonary symptoms of cough, fever, and weight loss (OR=2.84), perception that the symptoms will be relieved by oneself (OR=9.99), economic constraints (OR=6.58), and perception of the poor quality of healthcare services at hospitals (OR=7.32) were found to be significant factors of delayed TB diagnosis. Primary school- (OR=0.20), college- or university-level education (OR=0.42) and high-income groups (OR=0.39) were significant protective factors against delayed TB diagnosis. Marital status, occupation, residence, comorbidities, distance from healthcare facility, previous exposure to TB patients, fever, weight loss, chronic cough, hemoptysis, fear of diagnosis, fear of social isolation, and bad experience of the healthcare staff behavior were found to be non-significant factors for delayed TB diagnosis. The study only focused on delayed diagnosis and did not report healthcare system-related or total delay in tuberculosis management. The study affirmed the significant impact of patient perceptions and socioeconomic status on delayed TB diagnosis.

Pill aspiration is an uncommon but potentially life-threatening form of foreign body aspiration that requires prompt recognition and intervention. Unlike other aspirated materials, pills can cause unique airway reactions depending on their composition, solubility and coating, which may complicate both diagnosis and management. We report the case of a male patient in his early 70s who presented with acute cough and shortness of breath for 2 days following ingestion of his routine nighttime medications. High-resolution CT of the chest revealed a hyperdense lesion within the right bronchus intermedius. Flexible bronchoscopy under general anaesthesia confirmed the presence of a foreign body, which was successfully extracted in toto using a cryoprobe via rigid bronchoscopy. The retrieved object was identified as an aspirated calcium tablet. This case underscores the importance of considering pill aspiration in the differential diagnosis of elderly patients with acute respiratory symptoms after medication intake and highlights the role of bronchoscopic techniques in ensuring definitive diagnosis and safe retrieval.

Disseminated histoplasmosis (DH) is a common opportunistic mycosis in endemic regions, yet it remains underreported in pediatric patients with primary immunodeficiency or acquired immunosuppression. We present the clinical progression and fatal outcome of DH in a 12-year-old female from southeastern Honduras with an established diagnosis of Ataxia-Telangiectasia (AT) and Autoimmune hepatitis (AIH) managed with daily prednisone (1 mg/kg/day) and azathioprine (2 mg/kg/day), presented with fever, non-productive cough and progressive hypoxemic respiratory failure. Despite broad-spectrum antimicrobials, she rapidly developed severe acute respiratory distress syndrome (ARDS) and multi-organ dysfunction syndrome (MODS), culminating in irreversible cardiorespiratory arrest 24 h after ICU admission. Diagnosis of DH was confirmed via enzyme immunoassay (EIA) demonstrating high levels of antigenuria (15 ng/mL; threshold for high-level >5 ng/mL). This case highlights a critical therapeutic paradox where standard management for an autoimmune complication fully unmasked a lethal fungal infection in a vulnerable host. DH remains a notorious diagnostic mimicker in resource-limited settings where atypical presentation and delayed culture processing restrict timely polyene antifungal intervention. In endemic territories, proactive baseline screening for endemic mycoses and strict primary surveillance are mandatory before executing or maintaining intensive immunosuppression in pediatric patients with congenital immune dysregulation.

Valsalva retinopathy is a recognised cause of acute painless visual loss resulting from a sudden increase in intrathoracic or intra-abdominal pressure, leading to subhyaloid haemorrhage. While most reported cases describe rounded or boat-shaped haemorrhages, atypical morphologies documented with multimodal imaging are infrequently reported. We describe a 45-year-old female with long-standing insulin-treated diabetes mellitus who developed sudden visual blurring following a violent coughing episode. Fundoscopic examination revealed a sharply demarcated, heart-shaped subhyaloid haemorrhage involving the macula, and optical coherence tomography confirmed a subhyaloid haemorrhage. Despite intervention occurring almost three weeks after symptom onset, intravitreal tissue plasminogen activator combined with expansile gas resulted in significant anatomical and functional recovery, with visual acuity improving from 6/36 to 6/9 and sustained improvement on follow-up. This case highlights the importance of recognising atypical haemorrhage morphology, accurately localising haemorrhage depth using optical coherence tomography, and individualising management. It also demonstrates that delayed minimally invasive intervention may achieve excellent visual outcomes, even in the presence of pre-existing retinal disease.

Efforts to liberate patients from invasive mechanical ventilation (MV) begin when the underlying cause of acute hypoxemic respiratory failure (AHRF) or adult respiratory distress syndrome (ARDS) that led to use of invasive ventilation has resolved or improved and patients can initiate spontaneous breaths. In preparation for liberation, clinicians transition patients to spontaneous modes of ventilation as soon as possible while ensuring that patients' respiratory effort is not insufficient or excessive during weaning attempts. Concurrently, clinicians aim to minimize the effects of sedative and analgesic agents, screen daily to identify patients who are ready to undergo a spontaneous breathing trial (SBT), and conduct SBTs to help assess patients' readiness for extubation. Extubation failure is rarely the consequence of a single physiological abnormality. Rather, it reflects the interaction of multiple mechanisms that often coexist, including an imbalance between respiratory system load and capacity, ineffective cough, and secretion burden among others. For these reasons, single weaning parameters and SBTs may fail to identify some patients who are at risk for extubation failure. Conversely, indices and scores that combine two or more parameters and newer techniques may provide mechanistic insights into the pathways that lead to extubation failure, help to characterize 'at-risk' phenotypes, and identify patients who may benefit from closer monitoring, targeted therapeutic strategies, and/or early application of noninvasive respiratory support strategies such as high-flow nasal cannula (HFNC) and bilevel noninvasive positive pressure ventilation (NIV).

A healthy man in his 40s presented with acute anterolateral ST-segment elevation myocardial infarction after sudden-onset chest pain during a coughing episode. Coronary angiography and intravascular ultrasound revealed extensive spontaneous coronary artery dissection (SCAD) of the left anterior descending artery with Thrombolysis in Myocardial Infarction II distal flow. He was managed conservatively, but his course was complicated by severe left ventricular systolic dysfunction, apical thrombus and a ventricular tachycardia storm leading to cardiogenic shock. He required repeated emergency direct-current cardioversions, intravenous amiodarone, lidocaine and intra-aortic balloon pump support. Cardiac magnetic resonance imaging confirmed extensive myocardial infarction. Clinical recovery was achieved without revascularisation, and an implantable cardioverter-defibrillator was implanted for secondary prevention alongside guideline-directed heart failure therapy. At follow-up, he remained clinically stable. This case highlights that SCAD, although uncommon in men, can present with life-threatening complications and that carefully tailored conservative management with multidisciplinary input may achieve favourable outcomes.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), triggers symptoms including fever, persistent cough, and respiratory distress. By the week ending May 10, 2025, the Centre for Health Protection of Hong Kong reported a COVID-19 sample positivity rate of 13.66%, with XDV and NB.1.8.1 as the dominant circulating strains. Despite widespread vaccination and hybrid immunity in Hong Kong, breakthrough and reinfections remain common in vulnerable populations. Despite the long history of traditional Chinese medicine (TCM) and its proven effectiveness in epidemic control, its preventive measures against COVID-19, which have been widely adopted in mainland China, have yet to be integrated into Hong Kong's healthcare system. This study proposes a constitution-targeted preventive approach using TCM herbal formulas for Hong Kong residents at high risk of COVID-19 infection.

Left atrial myxoma is the most common primary cardiac tumor, although intratumoral hemorrhage remains exceedingly rare. We recently treated a 55-year-old man with a 37-year smoking history who presented with progressive dyspnea and leg edema caused by acute heart failure. Echocardiography revealed a large, pedunculated left atrial mass (54 × 27 mm) protruding into the left ventricle during diastole, causing functional mitral stenosis, as well as moderate mitral and tricuspid regurgitation. Contrast-enhanced computed tomography revealed a 30 × 46 mm intracardiac mass without definite feeding vessels or signs of hemorrhage. The patient underwent semi-urgent surgery 1 week after diagnosis, with complete tumor excision and concomitant mitral and tricuspid annuloplasty. Histopathological examination revealed a 5.5 cm myxoid tumor containing multiple intratumoral hemorrhagic foci with hemosiderin deposition, consistent with hemorrhagic myxoma. The postoperative course was uneventful. Intratumoral bleeding within a myxoma may result from rupture of fragile neovessels, potentially leading to sudden enlargement and mitral inflow obstruction. Awareness of this rare condition is essential for timely clinical recognition and appropriate surgical decision-making in patients with deteriorating left atrial myxoma.